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Individual
DR. NICOLE S JACKSON
Active
Individual
DR. NICOLE S JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
103TA0400X
Addiction (Substance Use Disorder) Psychologist
—
—
172V00000X
Community Health Worker
—
—
Other
Enumeration date
01/07/2014
Last updated
08/08/2024
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